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PHILIPPINES
– CIGUATERA FISH POISONING
An outbreak of suspected ciguatera fish poisoning (CFP) occurred in
Navatos, Metro
Manila, infecting 50 individuals as of June 22. The 50 cases were linked
to the
consumption of ciguatoxic barracuda. The Department of Health of the
Philippines
notified the public and warned against eating large, carnivorous predator
fish. The toxin
is produced by the Gambierdiscus toxicus microorganism and is consumed
by reef fish,
which are subsequently eaten by predator fish. Ciguatoxic fish can appear
and taste
normal, and cooking, drying, or freezing the fish will not destroy the
ciguatera toxins.
Symptoms of the food poisoning include numbness of the extremities,
diarrhea,
abdominal pain, chills, vomiting, and headaches. Outbreaks of CFP are
predicted to
increase with rising fish exports from Pacific Island Nations.
[PROMED 7/7/01]

THAILAND
– GOVERNMENT TO ENFORCE DENGUE FEVER CONTROL
MEASURES
The Thai government has imposed new measures intended to help curb the
spread of
dengue fever, which caused 87 deaths and infected 43,699 individuals
between Jan 1 and
June 30 of this year. The government plans to fine individuals whose
homes or offices
are found to contain breeding sites for the Aedes mosquitoes, the vector
responsible for
transmitting the infection. Aedes mosquitoes need clean, still water
in order to breed. The
Deputy Health Minister stated that this measure is modeled after a successful
method in
Singapore and is intended to encourage people to keep their areas free
of the potential
breeding grounds. More than 700,000 volunteers were expected to initiate
efforts to
destroy breeding sites throughout the country on July 9.
[PROMED 7/8/01]

SINGAPORE
– RISE IN DENGUE CASES
According to the Environment Ministry (ENV), 892 cases of dengue fever
were reported
in the first six months of this year, compared to 291 cases reported
last year. The weekly
average number of cases for this year, 34, is approximately three times
that of last year’s.
ENV officials are encouraging individuals to remove any stagnant water
found on their
premises and to monitor their areas daily for potential breeding sites
of the Aedes
mosquito.
[PROMED 7/12/01]

AMERICAS

U.S.
(UTAH) – RESPIRATORY ILLNESS AMONG TRAIL VOLUNTEERS
Eight of 16 volunteers who worked on trails at the Dinosaur National
Monument in late
June in Utah contracted a flulike illness. Seven of the infected
volunteers worked
primarily in an Indian sweat cave while the other volunteer worked
on a quarter mile trail
that led to the cave. Health officials suspect that a soiltransmitted
fungal pneumonia was
responsible for the infection. Volunteers who were infected came
from different parts of
the country, including one from abroad, while volunteers from Utah
and Colorado were
not affected.
[PROMED 7/6/01]U.S. (OHIO) – SHIGELLOSIS OUTBREAK IN TODDLERS
Over 700 confirmed cases of shigellosis have been reported this
year in Cincinnati and
Hamilton counties, with 539 of the cases occurring between June
1 and July 18 of this
year. In contrast, there were 574 confirmed cases in the same counties
during all of 2000.
The majority of the cases have occurred in diaperwearing toddlers,
their family members, and their caregivers. The infection is highly
contagious and is spread primarily through fecaloral contact. Symptoms
include diarrhea, fever, stomach cramps, and nausea. Ohio state
law requires children with shigellosis to complete a fiveday course
of antibiotics, wait two days, and provide two clean stood samples
before they are allowed to return to day care facilities. Health
officials are reminding those who deal with infants and toddlers
to be vigilant of the infection and to always wash their hands after
changing diapers or helping children in the bathroom.
[THE CINCINNATI ENQUIRER 7/13/01, 7/18/01]

U.S.
(TEXAS) – ANTHRAX OUTBREAK; HUMAN CASE
Hundreds of deer and several horses and cattle have died from probable
anthrax disease
in south Texas, where health officials have reported one of the
worst outbreaks of anthrax
since the late 1970’s. In addition, one human case of anthrax has
been confirmed and
another is under investigation. This is the first human anthrax
case in Texas since 1988.
The confirmed case is believed to have been exposed to the infection
while vaccinating
goats. Health officials are urging ranchers, hunters, and others
to avoid contact with dead
or sicklylooking animals. According to an epidemiologist with the
Texas Department of
health, the safest way to handle infected dead animals is by burning
their carcasses. The
area director for the Animal Health Commission has stated that he
expects more cases
until cooler weather arrives.

Anthrax
disease is caused by the sporeforming bacterium, Bacillus anthracis,
and is most common in agricultural regions where it occurs in animals.
Human cases often occur as a result of exposure to infected animals
or their products. Anthrax can be treated effectively with antibiotics.
[PROMED 7/12/01; CDC, http://www.cdc.gov/ncidod/dbmd/diseaseinfo/anthrax_g.htm]

2.
UPDATES

CHINA (HONG
KONG) – H5 AVIAN INFLUENZA VIRUS IN WHOLESALE
CHICKEN
A dead chicken from a poultry wholesale market tested positive for the
avian influenza
virus, H5, in early July. According to the Assistant Director of Agriculture,
Fisheries, and
Conservation, there had not been any abnormal deaths of chickens at retail
or wholesale
markets or any signs of sickness among chickens. Further analysis of the
virus will
include gene sequencing in order to identify the specific type of virus.
Authorities on
Mainland China were informed of the infection and have gone to the specified
farm for
further investigation. Health authorities in Hong Kong have asked that
farm not to export
live chickens into Hong Kong until further notice. As the avian influenza
virus is
endemic in China, control measures are not intended to eliminate the virus,
but rather to
help detect its presence before it causes an outbreak or mutates into
a more dangerous
virus that could affect humans. These measures include surveillance and
preventive
programs and a monthly “rest day,” during which markets can focus on cleaning.

In May of this
year, the sale of live chickens was suspended for three weeks and over
one
million chickens were slaughtered following an outbreak of the H5N1 virus
that caused
chickens to die within days of being infected. While no humans were infected,
health
authorities were concerned that the virus could combine with another virus
that would
allow it to infect humans.
[PROMED 7/10//01]

3.
NOTICES

UPCOMING REGIONAL
HIV/AIDS EVENTS

HIV and Families: the 4th
Australian Update on Pregnant Mothers, Infants, Children, and
Families Living with HIV/AIDSAugust 9㪢, 2001 at the
Sydney Children’s Hospital in New South Wales
Email m.goode@unsw.edu.au

International Training
Programme on Surveillance, Monitoring and Evaluation of
HIV/AIDS Programmes
September 17㪮, 2001 at the Indian Institute of Health Management Research
in Jaipur, India
Email iihmr@iihmr.org, rsgoyal@iihmr.org,
or visit http://www.iihmr.org

Sixth International congress
on AIDS in Asia and the Pacific: Breaking Down Barriers
October 5㪢, 2001 at the Melbourne Convention and Exhibition Centre
in
Melbourne, Australia
Email 6icaap@icms.com.au or
visit http://www.icaap.conf.au/

Fifth International Conference
on Home and Community Care for Persons Living with
HIV/AIDS: Power of Humanity
December 17㪬, 2001 at the Lotus Hotel Pang Suan Kaew in Chiang Mai,
Thailand
Email hiv2001@whothai.moph.go.th
or visit http://www.hiv2001.com

COUNTRY REPORT
OF HIV/AIDS IN INDONESIA
The Indonesian Health Department prepared a report on HIV/AIDS in the
country in
advance of the United Nations General Assembly Special Session on HIV/AIDS
(UNGASS). The report states the basic principles of AIDS control in Indonesia,
describes the current situation and observed disease trends, and discusses
lessons learned
and future actions. According to the report, Indonesia is considered a
lowprevalence
country, but a number of factors create the potential for the infection
to spread rapidly.
These factors include increasing rates of prostitution, domestic and international
migration, urbanization, tourism, poverty, and proximity to areas of higher
prevalence.
Similarly, infection rates have increased in injection drug users in the
past two years.
While the Ministry of Health has promoted condom use as a prevention measure,
particularly for highrisk populations, condom use remains a sensitive
and controversial
issue in the general population. The report cites a 1999 UNAIDS statistic
of 52,000 as an
estimate of the number of individuals infected with the virus, but the
Indonesian Minister
of Health, in his speech at the UNGASS meeting, described the current
total number of
cases of HIV as ranging from 80,000 to 120,000. The report and the speech
are available
at http://www1.rad.net.id/aids/PosPaperUNGASS.doc
and http://www1.rad.net.id/aids/MinHealthSpeechUNGASS.txt,
respectively.

POOR COUNTRIES TO RECEIVE FREE ACCESS TO MEDICAL JOURNALS
Medical schools, research laboratories, and government health departments
in poor
countries will receive free electronic access to approximately 1,000 medical
journals
under a program of the World Health Organization (WHO). The program is
expected to
benefit about 600 institutions, primarily in Africa. The program stipulates
that
institutions in countries where the per capita gross national product
(GNP) is less than
$1,000 a year would receive the journals at no charge. Countries with
a GNP between
$1,000 to $3,000 would be required to pay a minimal fee. The prohibitively
high costs of
many journal subscriptions for libraries and research institutions have
prevented many
developing countries from being able to access timely medical research
information.
Currently, most medical schools in developing countries have access to
fewer than 100
journals, while most American medical schools receive about 1,000 or more.
Participating publishers include Elsevier, Wolters Kluwer, Blackwell,
Harcourt General,
SpringerVerlag, and John Wiley & Sons.
[THE WASHINGTON POST 7/9/01]

SARA LEE RECALLS
13,600 POUNDS OF BEEF AND HAM
Sara Lee Foods is recalling 13,600 pounds of sliced beef and ham products
throughout
the country due to possible salmonella contamination. The company issued
the recall on
July 18 following the report that one person became ill after eating the
meat.
[ASSOCIATED PRESS 7/19/01]

4.
JOURNAL ARTICLES

ADENOVIRUS
–RELATED FATAL ILLNESSES
The Centers for Disease Control and Prevention (CDC) report on two case
studies of fatal
adenovirus infections in previously healthy young adults shortly after
their entry into the
Navy. From 1971 until 1996, all military recruits received oral, live
entericcoated
vaccines against adenovirus serotypes 4 and 7. In 1996, the manufacturer
halted
production of adenoviral vaccines, which prompted the military to establish
disease
surveillance for adenovirusrelated illnesses. These case studies describe
the first two
deaths associated with adenovirus infection following the unavailability
of the vaccine.
According to the report, the first case initially presented with upper
respiratory symptoms
and was prescribed azithromycin for bronchitis. He died nearly two weeks
later from
complications of encephalitis. Postmortem serum specimens revealed a greater
than
fourfold rise in neutralizing antibody titers to adenovirus types 4 and
7. The second case
initially presented with upper respiratory symptoms and later developed
dyspnea,
weakness, and a petechial rash. He tested positive for group A streptococcus,
and PCR
testing of lung tissue was positive for adenovirus DNA.

These cases demonstrate
the severity of the complications that can result from adenovirus
infections and point to the need for ongoing surveillance efforts and
continued vaccine
production. These cases also suggest that clinicians should be cognizant
of the
possibility of adenovirus infection in young persons in the military who
are severely ill.
[MMWR 2001;50:553𤰛, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5026a1.htm]

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